Relationship between CT coronary angiography and stress perfusion imaging in patients with suspected ischemic heart disease assessed by integrated PET-CT imaging

Carli, Marcelo F. Di; Dorbala, Sharmila; Curillova, Zelmira; Kwong, Raymond; Goldhaber, Samuel Z.; Rybicki, Frank J.; Hachamovitch, Rory

doi:10.1016/j.nuclcard.2007.07.012

Cited by 164 publications

(85 citation statements)

References 19 publications

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“…Thus, when ischemia is present (excluding artifacts), the likelihood of obstructive CAD is high. Additionally, the accuracies of CCTA for the identification of 82 Rb PET-defined ischemia were 67% for mild CAD (,50% stenosis), 85% for intermediate lesions (50%270% stenosis), and 93% for significant CAD (.70% stenosis) (7). Specifically, the likelihood of CAD in patients with severe myocardial perfusion defects is high (7).…”

Section: Inducible Ischemia Detected By Stress Myocardial Perfusion Amentioning

confidence: 99%

“…To date, 7 reports on the correlation between ischemia detected by stress myocardial perfusion (SPECT or PET) and CCTA have been published (2)(3)(4)(5)(6)(7)(8). Most of the evidence reveals substantial variability between inducible ischemia and atherosclerotic plaque composition and constrictive remodeling severity.…”

Section: Inducible Ischemia Detected By Stress Myocardial Perfusion Amentioning

confidence: 99%

“…Patients with CAD on CCTA frequently have normal stress perfusion findings (4). Another way to state this concept is that CTA is a poor predictor of inducible ischemia (7). In patients with 3-vessel or left main CAD, balanced reduction may result in normal stress perfusion findings.…”

Section: Inducible Ischemia Detected By Stress Myocardial Perfusion Amentioning

confidence: 99%

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Risk Assessment and Predictive Value of Coronary Artery Disease Testing

Shaw

Narula²

2009

J Nucl Med

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This review highlights and compares risk assessment, predictive accuracy, and economic outcomes for 3 commonly applied cardiac imaging procedures: stress myocardial perfusion SPECT or PET and coronary CT angiography (CCTA). This review highlights an expansive evidence base for stress myocardial perfusion imaging and reveals a decided advantage for higher-risk patients, notably those who have established coronary artery disease (CAD). It is likely that the use of CCTA will continue to expand, particularly for patients with more atypical symptoms and patients with a lower likelihood of CAD. Despite a high level of evidence, comparative research is not available across modalities that could definitively drive utilization of cardiac imaging modalities. Evi dence about the accuracy of a variety of noninvasive imaging tests for the identification of at-risk patients with known and suspected coronary artery disease (CAD) has been evolving. Most of the early published research on noninvasive cardiology, from the 1980s and early 1990s, focused on the diagnostic accuracy of a test. More recent research has focused on evaluating the ensuing risk in patients with normal and abnormal cardiac imaging findings. Further exploration has been aimed at the graded or directly proportional relationships between the extent and the severity of imaging risk markers and major adverse cardiovascular events. These relationships highlight a common theme throughout the literature of ever-increasing and worsening cardiac event risk with more extensive and severe imaging abnormalities. More recent topics in the prognosis literature are the utility of new technology, such as coronary CT angiography (CCTA), and its accuracy compared with that of conventional testing, such as stress nuclear imaging. For this report, we compare risk assessment, predictive accuracy, and economic outcomes for 3 commonly applied cardiac imaging procedures: stress myocardial perfusion SPECT or PET and CCTA. We further highlight the potential value of hybrid imaging with PET/CT or even sequential imaging with SPECT plus CT. CORRELATION BETWEEN MYOCARDIAL ISCHEMIA AND CORONARY ANATOMYEarly research focused on the accuracy of stress nuclear imaging for detecting obstructive coronary stenosis. Lessons learned from these evaluations were that the detection of obstructive stenosis was related to the severity of the stenosis, collateral flow, and underlying endothelial function. Documentation of high rates of false-positive results (i.e., ischemia with no obstructive CAD) with stress myocardial perfusion may be related to vascular dysfunction, an early marker of atherosclerosis. In addition, normal stress perfusion results in patients with CAD are related to many factors, including collateral blood flow or prior coronary revascularization. It is for these reasons that much of the recent imaging research has focused on risk determination. However, for discussion purposes, it is helpful to understand the relationship between ischemia and coronary anatomy. INDUCIBLE ISCHEMIA D...

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Section: Inducible Ischemia Detected By Stress Myocardial Perfusion Amentioning

confidence: 99%

Section: Inducible Ischemia Detected By Stress Myocardial Perfusion Amentioning

confidence: 99%

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Risk Assessment and Predictive Value of Coronary Artery Disease Testing

Shaw

Narula²

2009

J Nucl Med

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“…In the next years, image fusion and hybrid scanners will combine more effectively structural and functional information regarding the pathological sequence that goes from stenosis to ischemia (74)(75)(76)(77)(78).…”

Section: Diagnostic Performancementioning

confidence: 99%

Infarct characterization using CT

Grutta

Toia

Maffei

et al. 2017

Cardiovasc. Diagn. Ther.

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Myocardial infarction (MI) is a major cause of death and disability worldwide. The incidence is not expected to diminish, despite better prevention, diagnosis and treatment, because of the ageing population in industrialized countries and unhealthy lifestyles in developing countries. Nowadays it is highly requested an imaging tool able to evaluate MI and viability. Technology improvements determined an expansion of clinical indications from coronary plaque evaluation to functional applications (perfusion, ischemia and viability after MI) integrating additional phases and information in the mainstream examination.Cardiac computed tomography (CCT) and cardiac MR (CMR) employ different contrast media, but may characterize MI with overlapping imaging findings due to the similar kinetics and tissue distribution of gadolinium and iodinated contrast media. CCT may detect first-pass perfusion defects, dynamic perfusion after pharmacological stress, and delayed enhancement (DE) of non-viable territories.

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“…In fact, the value of CTA for predicting the presence of myocardial ischemia is limited. [8][9][10] While coronary CTA has an excellent negative predictive value, it is more limited in determining the significance of stenoses in patients with disease. Thus, caution needs to be exercised when adopting cardiac CT clinically.…”

Section: See Related Article Pp 625-630mentioning

confidence: 99%

Coronary flow reserve by CT perfusion

George

Bengel

Lardo

2010

Journal of Nuclear Cardiology

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See related article, pp. 625-630Cardiovascular computed tomography (CT) is one of the most impressive advances in the non-invasive diagnosis of cardiovascular disease in the last decade. Going beyond coronary calcium scoring, cardiovascular CT is capable of identifying calcified and non-calcified plaque, percent stenosis, cardiac structure and morphology, and left ventricular systolic function. The abilities to detect subclinical and obstructive atherosclerosis and exclude disease with high diagnostic certainty are its greatest attributes. Single-center and multi-center studies in various cohorts have established that CT coronary angiography (CTA) is an accurate non-invasive test for determining percent stenosis which can be performed with low radiation dose.1-7 However, it is important to point out that coronary CTA is an anatomical test that does not provide important physiological data. In fact, the value of CTA for predicting the presence of myocardial ischemia is limited. [8][9][10] While coronary CTA has an excellent negative predictive value, it is more limited in determining the significance of stenoses in patients with disease. Thus, caution needs to be exercised when adopting cardiac CT clinically. The importance of coronary physiology for diagnosis, prognosis, and guidance of therapies must not be ignored.Invasive measurements such as fractional flow reserve have been shown to impact outcomes in patients with coronary stenoses and guide the appropriateness of invasive therapies such as intracoronary stenting. 11-13Radionuclide myocardial perfusion imaging is an established diagnostic tool for detecting obstructive coronary artery disease and is proven to accurately predict prognosis and guide therapy.14-16 Furthermore, it has been shown to add incremental prognostic value above and beyond what is provided by invasive angiography. 17While the major focus of cardiac CT research has been its application in coronary angiography, our group and others have recognized that X-ray computed tomography using iodinated contrast as a tracer is capable of providing measurements of myocardial blood flow and blood volume. 8,[18][19][20] In this issue of the Journal of Nuclear Cardiology, Christian and colleagues use the upslope integral method, a previously described method published in the magnetic resonance perfusion imaging literature, to demonstrate cardiac CT's potential to quantify coronary flow reserve (CFR) independent of the arterial input function. 21 In summary, they performed dynamic CT perfusion imaging in a canine model that received intracoronary adenosine in one vessel supplying a hyperemic territory, while the remote territory was kept at baseline conditions. In addition, several experiments employed CT perfusion imaging during temporary occlusion of a vessel. Images were analyzed by measuring the attenuation changes over time in the remote and hyperemic territories and plotting time-attenuation curves. They then calculated the area under each myocardial curve during the upslope to peak of contrast e...

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Relationship between CT coronary angiography and stress perfusion imaging in patients with suspected ischemic heart disease assessed by integrated PET-CT imaging

Cited by 164 publications

References 19 publications

Risk Assessment and Predictive Value of Coronary Artery Disease Testing

Risk Assessment and Predictive Value of Coronary Artery Disease Testing

Infarct characterization using CT

Coronary flow reserve by CT perfusion

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